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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880948
Report Date: 09/27/2025
Date Signed: 09/27/2025 04:42:36 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/14/2025 and conducted by Evaluator Lavette Farlow
COMPLAINT CONTROL NUMBER: 56-AS-20250114105720

FACILITY NAME:VNL ARF II INCFACILITY NUMBER:
361880948
ADMINISTRATOR:ANN CLARKFACILITY TYPE:
735
ADDRESS:1205 W. BOHNERT AVETELEPHONE:
(909) 990-0299
CITY:RIALTOSTATE: CAZIP CODE:
92377
CAPACITY:4CENSUS: 4DATE:
09/27/2025
UNANNOUNCEDTIME BEGAN:
02:38 PM
MET WITH:Michael Clark, Administrator TIME COMPLETED:
04:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not seek medical attention for a client's injuries in a timely manner
Staff are not following reporting requirements
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Allegation: Staff did not seek medical attention for a client’s injuries in a timely manner. It is alleged that staff did not seek medical attention in a timely manner. Interviews conducted and documents revealed that staff did not take C1 to the hospital until 12/11/2024. According to the care notes and interviews staff became aware of the burn on 12/6/2024, but did not seek medication attention for C1 burns until 12/11/2024. LPA observed documentation that revealed staff did not seek medical attention in a timely manner. Based on file review and LPA observations, the allegation is substantiated.

Allegation: Staff do not follow reporting requirements. It is alleged that staff do not follow reporting requirements. LPA interviewed staff and reviewed the facility file. LPA observed care notes dated during the month of December. LPA observed Licensee care note indicating C1 had a seizure on 12/4/2024 and on 12/5/2024. DSP staff observed C1 using a flat iron on 12/4/2024 and instructed C1 to unplug the flat iron. During the seizure on 12/4/2025, DSP staff noticed the flat iron near C1 and pushed it away from C1. On 12/6/2025, DSP staff reported client having complained of pain in her leg in the daily care notes. Based on interviews and record reviews, the licensee did not follow the reporting requirements. The note clearly revealed that the licensee did not notify CCL of reportable incidents for C1. LPA reviewed CCL SIR logs and observed CCL has not received any special incident report regarding C1. Based on file review and LPA observations, the allegation is substantiated.

Two deficiency is cited as part of the California Code of Regulations, Title 22. An exit interview was conducted where this report, LIC9099, LIC9099C, LIC9099D, and appeal rights were discussed and provided to Administrator, Michael Clark.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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